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04/29/18 Doug McVay

This week, we listen to parts of a debate in the Scottish Parliament on whether, and how, to establish supervised injection facilities and safe consumption spaces. The motion to do so was introduced by the ruling Scottish National Party, and passed by an overwhelming margin. The spotlight now shifts to the UK Parliament, which is considering legislation to allow Scotland to set up a safe consumption space in the city of Glasgow.

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DEAN BECKER: The failure of drug war is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for decriminalization, legalization, the end of prohibition. Let us investigate the Century Of Lies.

The Scottish Parliament is currently debating a proposal to establish supervised injection facilities in response to growing numbers of overdose deaths. Needle exchange and syringe service programs are already well-established in Scotland as well as other parts of the UK, however the public health situation there, as in the US, requires a more expansive and innovative approach.

On April Nineteenth, the Scottish Parliament debated a motion to create a safe consumption space in the city of Glasgow. We’re going to hear parts of that debate now. First, let’s listen to Aileen Campbell, Scotland’s Minister for Public Health and Sport. Ms. Campbell is a member of the ruling Scottish National Party, and she introduced the motion.

AILEEN CAMPBELL: In 2016, 867 individuals lost their lives through problem substance use, and countless others were devastated by the loss caused by its impact. Alongside such loss of life, problem substance use can inflict pain, trauma and suffering on individuals, families and communities right across the country.

At a time when we are updating our national drugs strategy to take into account changes that have happened in the past 10 years, we have a chance to review and improve the services that we offer to people and the methods by which we engage with and support them.

Since coming into this post, the rising number of drug-related deaths has weighed heavily on me, I've very aware, given the nature of the population that we are talking about, and the allied challenges of austerity, that this pain will remain in Scottish society for some time.

Each number represents an individual loss of life, potential unfulfilled and a family devastated by grief. We cannot tolerate that, and therefore we need to examine what we are currently doing to help and support some of the most vulnerable people in our society and consider what we can do differently, even if it is unpopular or uncomfortable.

Sadly, we are not alone in facing that challenge, with other countries also needing to find ways to cope with problem substance use. However, the treatment and harm-reduction approaches that are taken vary, as do the results, so it makes sense to explore further those for which the evidence suggests that they can make a positive difference.

I have recently returned from Australia, where I was supporting our fantastic sportsmen and sportswomen at the Gold Coast Commonwealth games. Like Scotland, Australia has seen recent increases in the number of drug-related deaths. Between 2012 and 2016, the number of heroin-related deaths in Melbourne, Victoria doubled.

In an effort to seek a solution, the Victorian state Government looked to the successes seen in Sydney, which had introduced a safer drug consumption facility—SDCF—in 2001. In the 16 years in which the Sydney SDCF has been open, it has had more than a million visits from individuals who seek to use its facility. During that time, it has treated more than 7,000 overdoses without there being a single death.

It has also recorded an 80 per cent reduction in the number of ambulance call-outs to the area, the number of used needles and syringes discarded in public has halved and nearly 80 per cent of local residents say that they support the facility.

I have spoken with officials from the Victorian state Government about their recent decision to approve an SDCF in the North Richmond neighborhood of Melbourne. Like us, Victoria has chosen to treat the problems associated with substance use as a health issue rather than a justice one, which means taking a health-led response to the situation.

For the Victorians, that meant looking at the evidence for what works and what would reduce the number of deaths. They did not have to look far to see the impact that an SDCF could have.

Closer to home, just before I left for Australia, I addressed the Dundee community forum as it launched a drugs commission to explore the problems that it faces on problem substance use, amid a growing number of drug-related deaths, and to look for potential solutions.

At that forum, I explained that such solutions might initially seem controversial or unpopular, but we owe it to families who have lost loved ones and to those who have lost their lives to try something different, as the status quo for those furthest away from services is not working.

I am well aware that, for some, the idea of an SDCF is unpalatable and that the idea of offering a safe space for individuals to consume drugs seems wrong. However, I am clear—as is the Government—that our vision for this country is one in which all our treatment and rehabilitation services are based on the principle of recovery.

Indeed, that commitment lay at the heart of our 2008 publication “The Road to Recovery: A New Approach to Tackling Scotland’s Drug Problem”. For some people, the possibility of recovery or abstinence is a long way off. In the meantime, it is important that we focus on keeping them alive and in touch with services that may provide them with the support that they require eventually to take further steps towards their own recovery.

JOHN MASON: I agree with all that the minister says on the health aspect, but so far she has not touched on the supply aspect. It seems to me that the proposed model is built on people buying and selling drugs illegally, which is linked to organised crime. My main reservation about the policy is that we are building crime into the system.

AILEEN CAMPBELL: I do not agree with that assessment. It is about taking a public health approach to a public health issue. We currently do not have the powers to enable that to happen legally. That is why I am seeking Parliament’s agreement to enable us to ask the United Kingdom Government to give us the opportunity to take a public health response to the public health need in the city that John Mason represents.

An SDCF can offer a place where individuals can go and a safe space where they can be treated with respect, but it is also a place where they can build a relationship with treatment workers so that, if and when an individual decides that they want to make a change to turn their life around, they will have support on hand to do so.

An SDCF would be a real shift in service provision. It would be a service that has no barriers to engagement and one that provides a highly marginalised population with a place to engage with staff, build trust and get support to address some of the wider issues that they face.

Following a recent debate on the topic at Westminster, the UK Government minister came under attack for misrepresenting some of the evidence on such facilities, and I am keen not to make the same mistake.

Instead, I will defer to a 2017 report from the European Monitoring Centre for Drugs and Drug Addiction, which summarizes some of the evidence on these facilities. The report found that the evidence that SDCFs can “reach and stay in contact with” highly marginalized individuals is “well documented”.

The report says that “This contact has resulted in immediate improvements in hygiene and safer use for clients ... as well as wider health and public order benefits.”

Such facilities are associated with increased uptake of diverse types of dependence care such as referral to an addiction treatment center, initiation of detoxification programs and initiation of methadone therapy.

The report also states that evaluation studies have shown that there has been a “positive impact” on the communities in which the facilities are placed, including a “decrease in public injecting ... and a reduction in the number of syringes discarded in the vicinity”.

That is an important point in response to John Mason’s question. Surely those outcomes deserve exploration to ensure that our communities feel supported.

DANIEL JOHNSON: I hear much of what the minister has to say. If there is evidence, we should indeed look at it, but what she is saying is focused on intravenous drug use. What about the wider services and the engagement that goes beyond that cohort of intravenous drug users in tackling the wider drug problem?

AILEEN CAMPBELL: I am talking about that specific group and a problem with drug-related deaths. There are examples from across the world where countries have taken up the opportunity to proceed with such facilities, which has resulted in a reduction in the number of drug-related deaths.

I do not pretend that the measure would be a panacea for all the issues of drug and substance misuse in Scotland, but I am seeking agreement for us to try to initiate dialogue with the UK Government through which we can try to take forward a public health response to the growing and very real public health need that is felt keenly in Glasgow.

The evidence from the Sydney facility shows that it has had support from the local residential and business communities, because they have witnessed a positive change in the area as a result of the success of the SDCF. In Melbourne, locals actively campaigned for a safe injecting facility.

From the interventions that I have had, I am aware that, for some, the argument will be that there is no safe way to take a class A drug such as heroin. My answer to that is that SDCFs do not claim to make drug use safe; rather, they are based on the premise that it is safer to use drugs under supervision than to do so in a disused building or on the street or in any other place where an individual might take them and not be found should anything go wrong.

We rehearsed the arguments previously when setting up needle and syringe exchange programs. We did not claim that doing so would make injecting safe; instead, we claimed that the programs would make injecting safer by reducing the chances of the transmission of blood-borne viruses and bacterial infections.

An SDCF would also provide the opportunity for individuals to access the health and social care services that are usually out of their reach. On that point, evidence from the Sydney facility shows that about 70 per cent of the people who registered had never accessed any local health service before and that, since the introduction of the SDCF, almost 12,000 referrals have been made, connecting people to health and social welfare services in a way that never happened in the past.

ALEX COLE-HAMILTON: The minister is absolutely right to say that there is a link between safe injecting rooms and use of other healthcare facilities. A key service in that regard is the alcohol and drug partnership. Will she take this opportunity to confirm that budgets for ADPs will be protected in future? They have not been protected in the past under this Government.

AILEEN CAMPBELL: We have invested record levels in ADPs, and in the previous budget we committed to invest a further £20 million, to ensure that we can deliver on our new and refreshed approach to drugs.

Closer to home, the UK Government’s Advisory Council on the Misuse of Drugs published a report in December 2016 in response to the growing number of drug-related deaths in the UK. In that report, the council recommended that consideration be given to the establishment of SDCFs in areas with a high concentration of injecting drug users.

The council reported that in addition to the evidence that SDCFs reduce the number of drug-related deaths, there is evidence that they reduce the transfer of blood-borne viruses while improving access to primary care and more intensive forms of drug treatment. The council was clear that the evidence showed that the facilities did not result in an increase in injecting behavior, drug use or—I address this to John Mason—local crime rates.

All that leaves me wondering just how much more evidence in support of SDCFs the Westminster Government requires before it will act. How many more people need to die before the UK Government agrees that such facilities save lives?

The issues that I am talking about affect individuals and communities throughout our country, but it is Glasgow that leads the charge for Scotland in its attempt to open an SDCF. For that reason, I want to take a moment to focus on the current situation in the city.

The most recent statistics that I have seen indicate that the HIV epidemic in the city continues unabated. The outbreak among injectors in greater Glasgow involves about 120 people. Such a level of HIV infection is unacceptable in our society, and I am adamant that we must offer some solution to the situation.

If one in five of the people who inject drugs in and around Glasgow city center is involved in the outbreak, it seems essential that we should have a service that gives those people regular contact with services so that they can get effective HIV treatment.

In addition, Glasgow has had the largest number of drug-related deaths in the country in recent years, with 170 such deaths recorded in 2016. Again, the figure is unacceptable and the situation demands action.

I was encouraged by Glasgow City Council’s recent discussion on the issue. The discussion was initiated by Scottish National Party councilor Mhairi Hunter, but agreement was sought from members of all political parties on the need for a safer drug consumption facility to be introduced in Glasgow, and the discussion ended with a unanimous vote to pursue the provision of an SDCF in the city.

In addition, a Conservative councilor invited Amber Rudd, the Home Secretary, to come to Glasgow to see the situation for herself. The invitation was backed by the rest of the council, and I add my voice to those who are calling for the Home Secretary or her minister with responsibility for drugs, Victoria Atkins, whom I am due to meet next month, to discuss the pressing and urgent issues to do with substance use on which we are unable to act due to powers being reserved.

My officials have been involved in discussions with Glasgow health and social care partnership, which has been developing the proposal from the start. They will continue to engage with the partnership as things progress. I will also soon meet Susanne Miller, the chair of Glasgow’s ADP and chief officer of the health and social care partnership, to get a further update on the situation in the city.

We are currently working to renew our national drugs strategy. The current strategy has achieved a great deal and I pay tribute to the hard work of the people who were involved in delivering it: the ADPs, drug services, professionals, clinicians, people with lived experience and people from the third sector who introduced the world’s first national naloxone program, presided over a decline in drug use among our young people, supported more than 120 independent recovery communities and greatly reduced drug and alcohol waiting times.

NEIL FINDLAY: I support much of what the minister has said about injecting rooms. She is right to focus on that today, but will she bring to the Parliament a debate in Government time to allow members to discuss the whole issue of drugs and the holistic approach that we need to take to drugs policy?

AILEEN CAMPBELL: I am always happy to engage, indeed, I have sought to engage, with parties across the parliamentary chamber, to ensure that members feel a degree of ownership of our drugs strategy. We took forward our road to recovery strategy in that way.

I will happily engage with the member, who takes a keen interest in the issue, and I hope that he takes that commitment in the spirit in which it is meant, so that we can get something that delivers for people who are marginalized and vulnerable in the here and now, and make progress on safer injecting facilities.

Our refreshed strategy will seek to build on the achievements of the road to recovery strategy. It is also important that it seeks to rectify the gaps and shortfalls that have become all too evident. The new strategy must be innovative in its approach.

It must be guided by the evidence of what works and it must be unafraid to suggest approaches that might make some people uncomfortable, at first. That will include ideas such as SDCFs or heroin-assisted treatment. Against the backdrop of rising numbers of drug-related deaths, those bold ideas could be what makes the difference.

It is important, however, that we do not view such approaches as a panacea for all the challenges that we face with problem substance use in Scotland. Again, I would welcome all members who want to contribute to the refreshed strategy.

The strategy will be backed by an additional £20 million each year during the current parliamentary session, and I have been clear that that money is not just to produce more of the same. Instead, I want it to encourage new thinking and approaches, and to encourage ambitious and innovative front-line responses.

Unfortunately, at this time, we are, to an extent, curtailed in what we can do as a nation in response to the problems that we face from substance abuse. The options that are available to us under current legislation are limited, but the situation in Glasgow is serious enough to warrant considering alternative approaches, including a supervised consumption room. I am pushing for a change in the legislation to let that happen.

There are SDCFs in more than 70 cities around the world, but not one in the UK. Such a position is no longer tenable and I seek the consensus and agreement of Parliament to help change this.

DOUG MCVAY: That was Aileen Campbell, Scottish National Party and Scotland’s Minister for Public Health and Sport, introducing a motion in the Scottish Parliament to set up a supervised injection facility or safe consumption space in the city of Glasgow.

Scotland is still part of the United Kingdom. There was an attempt not long ago to establish Scottish independence, however that referendum failed narrowly. The UK government made several major concessions to Scotland before the vote in order to scupper the vote, and some powers have been devolved to the Scottish Parliament from the UK government.

Unfortunately, establishing a supervised injection facility falls somewhat outside the scope of the Scottish Parliament's power. That’s why Alison Thewliss, a member of the UK Parliament from the Scottish National Party, has introduced legislation to allow Scotland to set up supervised injection facilities.

Several nations around the world, including Canada, Australia, Switzerland, the Netherlands, Germany, and many more, already allow these safe consumption spaces. The research is clear. Supervised injection facilities and drug consumption rooms do not lead to increased use, nor to crime, nor to public disorder.

Supervised injection facilities and drug consumption rooms do prevent people from dying. They prevent people from getting sick, and from spreading disease. They bring people into contact with healthcare and mental health services, people who may otherwise be disconnected from those systems.

The research is indisputable. The real world experience is undeniable. It’s clear what works. It’s also clear what doesn’t work, and our current policies, based on prohibition, do not work.

Change can happen, it does happen, it will happen, because we make it happen. Our voices matter. Our votes count. Never let anyone tell you otherwise.

The prohibitionists, the people against reform, know that they can only succeed is if they can get us to shut up, and that’s just not going to happen. Not so long as there is still breath in my body to be able to say these words: You are listening to Century of Lies, a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.Net. I’m your host Doug McVay, editor of DrugWarFacts.org.

Now, while I climb down from my high horse, let’s continue listening to that debate in the Scottish Parliament over supervised injection facilities and safe consumption spaces. Now, let’s hear from Anas Sarwar, he’s a Labour Party member of the Scottish Parliament who represents Glasgow.

ANAS SARWAR: The increase in drug-related deaths is a tragedy—it is a tragedy for the individuals concerned, for their friends and families, and for society. Scotland tops the league table in the European Union for drug-related deaths, and the position is getting worse, not better. In the past decade, the drug-death rate has doubled. Drug deaths in Scotland are 160 per million of population, while the EU average is 21.

It is not just an issue of ageing drug users. Drug use among young people is, I believe, as prevalent now as it has ever been. The substances might not all be the same, but we are kidding ourselves on if we believe that young people are not using drugs. MDMA, legal highs, cannabis, cocaine and others are rife in communities across our country.

We cannot allow ourselves to be viewed as distant “suits” who are out of touch with reality. Sadly, much of what we see on our television screens and at the cinema continues the glorification of some forms of drug use.

That is why we must, with honesty and in good faith, consider whether the current approach is working. This is not a political attack on the Scottish Government’s current drug strategy; it is a candid reflection that we are failing as a nation. I say that in full recognition that drug deaths have been steadily increasing since 1995. For long periods since then, my party has been in power.

I want to make it clear that I do not believe that we can continue as we are. That is why, today, we will support the Scottish Government’s motion. I hope that the Government will recognize the good faith of our amendment and support it, too.

This is far too serious an issue, with far too many lives being lost and families affected, for it to be used as a political football or as a proxy for constitutional conflict between the Scottish and UK Governments. We should not allow it to become that.

Whatever position we agree today, we have to be honest enough to say that safe injection facilities are not the answer in themselves. Whatever benefits they may bring, they are not the magic bullet for solving Scotland’s drug problem. Nobody in the chamber is seriously suggesting that one injection room in one part of one city is an adequate response to Scotland’s very serious drugs problem, but it may well have a part to play,

We believe that, if necessary, powers should be devolved if all other avenues have been exhausted. In supporting the Government’s motion, however, we are not willing to give the Government a free ride. There are serious questions to answer—not the least of which is how the minister believes that cutting the funding to drug and alcohol partnerships will make things better.

A budget that was more than 69 million pounds in 2014-15 is a budget of less than 54 million pounds now. It cannot simply be written off as a coincidence that, over that period, the number of drug-related deaths has increased sharply, and it cannot simply be a coincidence that the health impacts of dirty needles are increasing when needle exchanges are closing down. I would therefore welcome the minister’s explanation of how the cutting of budgets has made a positive difference, if it has.

I come back to the motion. Labour supports the Glasgow safe injection space proposals, but it is clear that we need a wholesale change in the approach to our drug strategy. Why? It is because the evidence that is before us is stark: whatever else our drug strategy might be, it is not a success. Our drug strategy is failing: it is failing individuals, families, whole communities and our nation.

AILEEN CAMPBELL: I appreciate a lot of what Anas Sarwar has said and how he has articulated it. However, I worded the motion as I did in order to ensure that we focus on one element of drug policy so that the issue does not become a constitutional issue and we could achieve consensus.

However, on the reference to a “failing” strategy, will Anas Sarwar concede that there have been successes, and that many people do not want to rip up the current strategy but to build on it? We have had the first-ever national Naloxone roll-out program, we have seen a reduction in numbers of young people who are taking drugs, and we have a flourishing recovery community.

All those can trace their roots back to the road to recovery strategy. We know that the strategy has shortfalls, but we want to plug any gaps. However, that does not suggest that the entire strategy and approach has been a failure. In fact, saying that it has been a failure does a disservice to the many people who are working incredibly hard to deliver it.

ANAS SARWAR: I emphasize that what I am saying is not an attack on the Scottish Government, the existing strategy, the minister or the people who are doing lots of very important work across the country. What I am saying is a reflection on the stats and facts, the numbers and the evidence on the ground.

I note what the minister says about young people’s use of drugs, but I am sorry to say that that is not what I understand from my experience of talking to young people the length and breadth of our country. Young people are now seeing drugs in a much more normalized way.

There seems to be increased drug use among crisis individuals and people in crisis families, but what worries me is that there are lots of people right across the country who would not be regarded as crisis individuals or as being in crisis families who are normalizing use of drugs.That might not be about intravenous drugs like heroin, but about legal highs, MDMA, cannabis and cocaine. That is why I think that we need a fresh approach.

There is a large degree of consensus across the chamber on the issue, and some of that has been articulated. I think that there is a large degree of consensus among people who work with drug issues every day across our country. That is why we are committed to taking a fresh and wide-ranging approach to dealing with our country’s drug problems.

ALISON JOHNSTONE: Will the member take an intervention?

ANAS SARWAR: I am willing to, but I think that I am running out of time.

CHRISTINE GRAHAME: The member is coming into his last minute, but I will give him a little extra time as he took a long intervention previously.

ANAS SARWAR: Thank you.

CHRISTINE GRAHAME: Your intervention must be brief, Ms Johnstone.

ALISON JOHNSTONE: I am not entirely clear about whether Anas Sarwar sees substance misuse as a public health issue or as a criminal justice matter, so I would be grateful if he could clarify that.

ANAS SARWAR: I am just coming on to that. I see substance misuse as a public health issue. The complex nature of substance abuse means that it must be addressed across portfolios. We should look not only at our justice system, but at policing, housing, local government and, more important, the impact of poverty, inequality and austerity on the prevalence of drug use.

That is why Labour will hold a wide-ranging cross-sector and cross-portfolio drug summit to consider innovative ways to improve the policy and political response to Scotland’s addiction problems. I think that Alison Johnstone and I are probably very much on the same wavelength in terms of making the issue less about a criminal justice reaction and more about public health.

We should seek to learn lessons not only from around Scotland and the UK but from all around the world, so that we can see how other countries have changed their approach and, as a result, changed levels of drug use. There are bold and innovative examples, Portugal being one, but I will not go into detail, given the time that I have left. However, we need to be brave enough to consider innovative proposals in a cross-party way.

Simply doing the same things over and over again, with the same forlorn hope that things might be different in the future is not the definition of an effective evidence-led policy.

So I close by urging the Scottish Government to do as the minister has said and not use our support for the motion as a proxy for a different disagreement, but to use it, and the willingness of members across the chamber, to take a fresh look and to consider new ways so that, years from now, people can look back and say that today, in the Scottish Parliament, we began the process of turning around Scotland’s place as the drugs-death capital of Europe.

DOUG MCVAY: That was Anas Sarwar, a Labour Party member of the Scottish Parliament from the Glasgow constituency.

At the end of this debate, votes were taken on amendments and then on the motion itself. All amendments were rejected. The motion passed by a vote of 79 in favor, 27 opposed, with one abstention.

Now, loyal listeners will recall that we heard part of the debate in the UK Parliament on its supervised consumption facility bill on a recent show. Parliament will soon have its second reading and debate over that legislation, to allow Scotland to set up that safe consumption space. When the time comes, I’ll bring you that audio.

Until then, I just want to thank you for joining us. You have been listening to Century of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I’m your host Doug McVay, editor of DrugWarFacts.org.

The executive producer of the Drug Truth Network is Dean Becker. Drug Truth Network programs are available via podcast, the URLs to subscribe are on the network home page at DrugTruth.net.

The Drug Truth Network is on Facebook, please give its page a like. Drug War Facts is on Facebook too, give its page a like and share it with friends. Remember: Knowledge is power. Follow me on Twitter, I'm @DougMcVay and of course also @DrugPolicyFacts.

We'll be back next week with thirty more minutes of news and information about drug policy reform and the drug war. For now, for the Drug Truth Network, this is Doug McVay saying so long. So long!

DOUG MCVAY: For the Drug Truth Network, this is Doug McVay asking you to examine our policy of drug prohibition: the century of lies. Drug Truth Network programs archived at the James A. Baker III Institute for Public Policy.